Posted in Conflict world wide, History, War

The Women in War

(An Armistice Day poem especially written for the fallen heroes of WW1 for this day, a century after the war began back on August 4th 1914.. This is for all the women that they left behind.)

Can you see my tears in the wind, like rain falling on those rivers of mud?

The brown lanes of toil, though not for fields of life, or grain and green but of red and raw, flesh and blood.

The rivers of life running dry, cut down like the sickle on the corn.

Stripping the dreams of souls who saw a future’s bright on that summer’s morn.

And we wait in the wings of this theatre called war, for a word inscribed with a numbing blow.

For a script no-one could really rehearse, nor who would want to act out the play.

This plot of death with so short a scene to become more than just One Act,

in the voids of senselessness and despairing called The Trenches.

So we call your name in the abyss of our loss.

Your image frozen in time and on our praying lips.

For the hope that we hear your boots coming back to us, mixed with the sun, the leaves, the dust.

The clock ticks to the rhythm of our hearts, for a longing of return now we’re apart.

As the sun goes down on another day and as the darkness forms once more.

We listen for your humming song, against the gun and cannon raw.

Your lives feels lost whilst you still may live and as the bird song calls, the mist lifts.

To another day laid waste and bleeds, entwined with our desperate need.

To know that you are safe, alas, we call, but no-one answers their name.

Let us hope at least that when war finally ends and your futures lost,

The waste was not in vain but for gain, though we scarce know why it had to be this way,

Stripping the dreams of souls who saw a future’s bright on that summer’s morn.

@onethoughtfulwoman Nov 2014.

Posted in Change, Debate, goals, Government, Health, History, Human Rights, Ideas, Modern society, Politics, Skills, Thoughts

Government Policy And The NHS.

When something is going wrong in a system of work,fingers naturally will often point to the management structure. Senior staff can be questioned, managers decisions criticized.in this case with the NHS, the biggest manager and where the buck totally stops, is with the Government of the day. They have the overall say in how our NHS is run.

I am no expert here on figures and am not a statistician . What I can say can only be based on what I have seen for myself and read in the media. So let’s take the Mid Staffordshire case. The horrific situation of systematic failings in care was largely created by a catalyst of cost cutting and the relentless drive towards becoming a Foundation Hospital. In order to become that,(foundation status means more self-governing) the hospital had to slash debt, have improved performance targets and be seen to be keeping on track, not only in budget but what it could show on paper to be improvements, efficiency and throughput.

In-fact, this objective is part of every hospital up and down this country. Along with this, the Private Finance Initative called PFI’s was introduced by the last labour government and its impact have made the present situation even worse. PFI’s are loans to hospitals to rebuild, improve and to makeover old hospitals into shiny, spanking new ones. However, many of us will know the outcomes of hospitals struggling to pay off these loans. They have been left with huge debts and deficits.

Then, on top of that, we have fines if certain targets are not met. If a patient goes over a four hour waiting time to be discharged from the Accident Emergency Department to a ward, transferred to another unit or sent home, the hospital is fined. If an ambulance does not deliver and dispatch a patient in a certain time span, it is fined. This is all supposed to be about improvements in performance, get the stick of financial punishment out, and somehow magically results will be produced forthwith. But what has happened? As wards shrink in size, as hospitals slash inpatients beds and staff to save money, there results in a chaotic rush of bed juggling, and the frantic efforts to free up beds against fewer manpower resources. If a patient is discharged and then that patient is what we would term a “bouncer”, that is to say they are re-admitted within a certain time frame,the hospital gets… you guessed it, a fine!

How are hospitals suppose to stay on track budget wise if all they are threatened with is fines? This is government policy now and it is doing nothing to help patients with their care.Infact, this only creates more pressure to treat a patient as a price tag, a unit, a juggling ball on a bed; and leads to what we have heard about bed moving in the middle of the night, against the tide of complaints of sleep deprived patients on wards. It’s like musical beds. Patients become little more than another stat to be got through the system as quick as possible. Now we have jobs purely for bed managers and early discharge assessors and the term, the “bed- blocker” comes to my mind. This is when someone is stuck in the system with no outlying community bed to go to ( because they have been either cut or closed) but they can’t go home either.

Never has the pressure for beds and timed targets been so great as it is now; with increased population, sicker older people, increased expectations of the population to be seen and treated and the changes in GP’s out of hours care. Literally hospitals are fit to bust…..

I leave you with a question. How can these government-led poliices be conducive to quality total patient care? And the nurses, as well as other NHS staff, are caught right in the middle of it. I tell you something: it makes for a hell of a lot of stress. It does nothing to help health-care professionals, with their own mental health, who are suppose to be angels or compassion, care and tranquillity, when really they are tearing their hair out, to give this essence of care that is talked about….

Tomorrow: An example of the crazy burden of data collection and why ultimately I left NHS Nursing.

Posted in Change, Debate, Development, Government, Health, History, Modern society, Politics, Psychology, Religion, Skills, Thoughts, Uncategorized

Good Leadership Skills Within the NHS: Are They There Or Not?

During my nursing career of 28 years within the NHS, I worked with only three exceptional leaders of people. Two of those leaders worked together in the same unit. One was senior to the other and both worked in harmony together. It was some of the golden days of my NHS life.

When you have a good boss, it shows through and through. You feel valued, invested in and your opinions matter. There is a fairness and compassion within that person. They are interested in people, usually are highly skilled and experienced in their field and have a humane and caring character. They have disciple within themselves and enhance and encourage that in the workplace. The atmosphere in the place of work is happy, standards are high and efficiency prevails. When you are asked to perhaps stay late, or to help in a crisis of staffing, you will come forward because you invest in your workplace, in return for how you are treated. Well, that was how it was for me anyway. 

Sadly, overall leadership within the NHS is poor in my opinion. There are good leaders in the NHS of course and these ones stand out. However, a good leader is often challenged by higher management, if they are not a “yes man” and not always popular with that seniority. In the end these people leave and go on to other positions, leaving the vacuum and the loss behind. Poorer management often comes in as a result and then staff leaves and recruitment/retention gets harder. Moral goes down: stress goes up.

I think one of the problems for nursing is a lack of experience in leadership. Historically, to become a ward sister, at one time, you needed to be qualified for five years.

This is now a dreadful statement to make but I have heard someone say once, that nurses are like “painters and decorators”, you climb the ladder so fast that you scarcely come into contact with any patients. This is a simplistic and rather brash view, but the point here is that, I personally feel that the quality of those in charge, in terms of interpersonal skills with people, CAN be lacking. There just isn’t that core backbone of personal standards, discipline and integrity that there once was.

Then at the heart of the matter, combine these factors with nurses who do not feel listened to by higher management. They feel dis-empowered, that no-one really cares and that they are just a number, easily dispensed with and easy to replace. Challenge anything with anyone who is in a higher position than you and you will often come out worse. Employees can easily feel start to feel vulnerable. Conflicts and bullying are present in the NHS, just as they can be in any large employing organisation. Staff feel threatened and gagged if they dare to speak out. Confidentiality clauses are cited as a means of fear to shut people up for fear of losing their jobs or being frog-marched up to the NMC ( Nursing, Midwifery Council) professional conduct committe. Nurses are in a terrible dilemma if they feel standards are being compromised, yet have no confidence in any leader to talk to or simply feel too afraid. They trust no one. Both the Royal College of Nursing and the NMC have issued guidelines on how to whistle-blow professionally but too few are still prepared to blow that whistle at a local level with a mortgage to pay.  

Finally, it is in my view that the NHS also operate within a very rigid and hierarchical structure. Everyone knows their place in the pecking order from cleaner, to porter, from nurses to doctor and consultants. There is less snobbery now between those at the top of the management tree to those at the bottom; and nurses are no longer seen merely as doctor’s hand-maidens due to their increased technical and skilled roles. Thankfully, there has been this shift ( enhanced by our increasing number of graduate nurses) but both leadership qualities and this persistent hierarchy remains an issue……

On Monday: Management decisions at the very top- Government policy. How PFI’s and the obsession for targets and figures are critically wounding our NHS.

 

 

 

Posted in Change, Debate, Government, Health, History, Ideas, Modern society, Politics, Skills, Thoughts

The Role of the Qualified Nurse. Past and present

When I qualified I remember what was then called ” task-orientation.” We started in bay one and went, in two teams, up and down the ward with our care and our trolleys. With aprons on, we washed and turned, fed and hydrated our patients. Every chart was filled in, everyone seen, mobilised, toileted. Dressings were done,medication was given and when that was finished we went off to separate breaks ( one team at a time) and then came back and started it all over again.The ward sisters -there were two of them had an eye on everything. Nothing was missed and woe betide you if it was missed. The ward sister was the heart and the nucleus of everything. Doctors went to her, everyone went to her. She often took the phone calls. She managed everything. I was lucky as I was on a strict but excellent ward in terms of care. There was no shortages of nurses wanting to work on this ward.

However, task orientation was criticised. It was not giving personalised, individual care. People were not a set of tasks but with unique and differing needs. The regular “Kardex”, as it was called then, of writing up the care was changed. Up to this point it had been short and concise. An idea from America came to our NHS,it was shaped on the Roper’s Model of Care:it was called the Nursing Process. This was the first of the mountain of paper that emerged.It meant that all patients had to have an individual care plans for every activity of living. These were first hand written and then when I left nursing they were typed photocopies and had become little more than tick-boxes, another task in my opinion.

Then something else happened which changed our role. Doctors were working sometimes 80 hrs a week, being on call etc and this was rightly considered too much, something had to be done. With this concern came an increase in technological advances in care. Patients who might have died now lived with advancing medicines, diagnosis and procedures. Slowly, the nurse practitioner would be born out of all of this. However, in the mean time sisters were becoming bleep holders, budget holders and bed managers. Staff nurses became clinical shift leaders and I was told to take my apron off and start running the ward instead. There were still qualified nurses and nursing auxilaries doing the care, but what was once undertaken in a higher dependency unit was now becoming mainstream on the wards. This was very marked for me when I returned to acute nursing after working for four years in elderly care rehabilitation. The work load even by then was becoming more stressful.

So registered nurses paper-work increased, more advanced skill became the norm, including venepuncture, cannulation, IVI drug administration to name a few. Hotel workers replaced nurses both qualified and unqualified in giving out meals and drinks. The nurse mentor was born and he/she was now responsible not only for patients but for students as well. This was all happening when I left acute hospital nursing in 1993. I left and went into community after a particular night when one visitor came up to me and said:

” Hello again, there are two things I observe about you. One is that you are always here and two you are always writing out bits of paper.”
It is now 2013 -20 years has passed since then.

Now multiply what I have said a few times more, as demand for services, changing clinical roles, paper, stats, sicker older people, European Economic Community patients needing care, cuts in resources, cuts in staff and you can begin to see why we are in the current crisis situation. Also, crucially from the very top of the decision-making tree, our government and senior NHS management, who increasingly see patients as a entity of profit-making and not focusing on them first as someone needing care. No wonder the Government is stating that it is costing just all too much and auctioning the whole care parcel out to who ever can give the best price…..

Tomorrow: Let’s start to look at leadership within the NHS.

Posted in Atheism, Christianinty, Debate, God, History, Learning, Philosophy, Religion, Thoughts, Time, Uncategorized

Upon The Millennium Bridge.

OLYMPUS DIGITAL CAMERA

The symbol of a divine power and fear looms across the swaying steel.
Stone and metal,old and new.
Menacing perhaps,yet an awesome beautiful dome.
No-one who walks across the tide can escape the view,
A commanding scene where thoughts may stir of What might be,after this place of earth and dust.

The Little People scurry like ants both away and towards the imposing place,
Questions and yet also a vacant possession amongst the traveller’s minds upon the Millennium Bridge.
A mulling of crowds thinking about their day,
Where are they going? To heaven or to hell?
Or perhaps to simply no-where but across the tide of steel to another destination.
The moment moves on and so does the ticking clock of time nestled in the tower of monsters and angels.

Science builds the bridge and dogma builds the building.
Reason has it that no-one really knows why we are here, or who or what has placed us upon this World
But science tells us more about the building blocks, than faith that built the rocks of that solid place.
Some walkers are curious, some don’t care at all
Some cry forth that the answers of creation is called The God.

The sky looms in and growls like a angry lion, as big and as mighty as God himself?
Is there something in the clouds and that infinite space that holds the answers to all of the universe’s questions?
Be that a God or a gas.
For now the bridge sways in the wind and the clouds travel on ahead,
The pedestrians continue on their way and forge their own path, and hazzard their own quesses to the big questions upon the Millennium Bridge.

Onethoughtfulwoman Feb 2013

The Image of the Millennium Bridge is placed here with kind permission of James Rye @athinkingman whose images appears on flickr and is reproduced here specfically to highlight this work. He has sole copyright and is the owner of the photo. May I take this opportuinty to thank him for loaning this image here.

Posted in Art, Atheism, Christianinty, Debate, God, History, Ideas, Men, Philosophy, Psychology, Relationships, Religion, sex, Thoughts, Time, Uncategorized, Writing

The Angel’s Game: Part 2

I wasn’t sure how I would find The Angel’s Game after the excellent, if not involved and sometimes confusing plot, of  The Shadow of the Winds. However, after reading the first two pages I knew this book was going to surpass and excel beyond “Shadows” and it did not disappoint, I could barely put it down.

What I love most about this book is the rich, poetic, elegant flow of words that help to create this magnificent tale of a writer who sells his soul, perhaps for fame, for money or both by being given a commission to write a book. This work is like no other, from a mysterious publisher for a vast sum of money. From the start Carlos Ruiz Zafon makes it clear what he is trying to say. For a man’s ego, sometimes he is prepared to do anything, even with his own near destruction at stake.

The depth of how the author created the characters and how each one was woven and intertwined with the story is something that Zafon does superbly. You could feel the desperate obsessive love that David Martin, the central character, feels for Cristina and how this relationship unfolds. You are not sure at first how the added relationship of Isabella is going to go, this held me the most, and I wanted to cry when reading her last letter to him. This was truly moving and haunting words so tragic and so authentic feeling real to me.

David Martin was intellectually a sharp and essentially good man, yet numbed by years of being let down and abused, he was turned into a character of coldness and unfeeling at times, seen especially in his interactions with his doting young assistant Isabella.  Yet, his drive to survive and to find the truth concerning the darkness of where he lived, that was linked with his own work, gave this novel a sometimes creepy, supernatural air about it. Turing into a detective tale set in a Gothic theme, this enriched the whole fabric of the novel and gave the plot a nail-biting feel. Just when you thought there was nothing new to add, a twist emerged and you were once again thrown head long into the pages of a tale intense and demanding to its audience. You had to concentrate, otherwise you would lose the thread of the plot.

Then the end: how strange. I read it twice and could not take it in. Had I missed something? For me, it left unanswered questions and a feeling that suddenly where it had been convincing it became a non-reality. Why has Zafon done this other reviewers have asked? It was a clever turn and the author’s notes for discussion could say why. Who was the publisher? I have my thoughts which would make the end plausible. Never-the-less I am hooked. I can forgive him for the ending though as I want to read much more from this man. It is hinted in reviews that with the completion of the four novels Zafon prepares to write, the end of The Angel’s Game slots into place. Is this up Zafon’s sleeve? Knowing his writing a little then nothing would surprise me.

If you want a book where you can enjoy some history, feel the city of Barcelona on your finger tips, with skilled and crafted writing around a great plot then read Zafon. It’s poetry from a pen and characters that come alive.  It is the only novel on finishing that I felt I want to read again and along with it The Shadow of the Winds. I  was not aware that The Angel’s Game was joined to “Shadows” until the final twists at the end. It was an Ahh moment. They can be read alone or as a complete story, the Cemetery of Forgotten Books being the cement that link and binds them together. A great find for me in fiction, like no other for a long time. For a thinking mind it is a great read.

(The images are photographs taken at the Monastry of Pedralbes visited at the time of reading and one area featured in the author’s work. The angels are a perfect choice of picture for this blog I felt.)

Posted in achievement, Change, Debate, History, Ideas, Learning, Liberation, Modern society, Politics, Role of women, Skills, Thoughts, Time, Uncategorized, Women

Titanic disaster: class division and inequality. One hundred years on has anything really changed?

This is my 100th blog post on WordPress and the 100th anniversary of the sinking of the Titanic on her maiden voyage. To commemorate both of these anniversaries, I decided to write this blog around the theme of this maritime disaster. A topic that still ievokes passion today, as it did back then in the previous century. It is the subject of class: social class and the huge inequality between rich and poor. The divide of wealth against poverty, privilege against opportunity, social fortune against hardship.

In the cold, iceberg littered waters in the North Atlantic sea, approx 1,500 people perished on the night of the 14th/15th April, 1912. At 11.40 pm, an iceberg blew five of the 16 compartments, the design of which was to prevent the ship from sinking. Had there been one less damaged, the ship would have stayed afloat. The sinking was cruel and quick. At just before 02.20am, the ship cracked in two, against the opposing forces of water pressure, against the lean of the ship.  The odds of dying were very much marked by where, depending on which class of deck you travelled. The lack of lifeboats, their half filled capacity and lack of organisation in the evacuation meant that less than a third on board survived. No truly accurate figures are known of how many survived, given the ship’s passenger logging system at the time. And paradoxically, whether you were a woman or a child for once did have an advantage. Against the tide of the women in the suffragette movement who were risking their lives and freedom in another way to gain the vote and a voice. Men being a dominant force in an unequal society towards being female was centuries old. However, being a women not a man, for once, was a huge advantage that night.

I have been following the ITV1 series of Titanic, the focus of which has been the stark snobbery and deep class division and segregation of those who had, against those who had little or nothing.This rigid British society was based on the have and have-nots and men versus women. The rich and the poor, the titled and the unknown. The pecking order of who was who, the hypocrisy of the people of the time. Even the hierarchy of the servants in first class, to second, from second to third. The locking of the ship’s deck doors so the rich did not have to mingle with the poorer travellers. This factor alone was a disaster for those in 3rd class who may have survived. The ship’s church service, the only time that these second and third class passengers could venture upstairs and worship together-obviously God did not mind such integration on that occasion. And God’s people allowed that!

When it came to the lifeboats, it was women and children first, but class was a central factor. You needed to be a first-class traveller and female on that night. Only three percent of first-class women died compared to 54% of third-class women. 92% of second- class men perished and 84% of third. You can see here the account of the disaster, how and why and who survived from which class.  At the time, there was public outrage at what happened but also the fact that the poor died in the highest numbers. Sweeping changes were made in maritime law which still exist today.The question I asked myself before writing this blog was, has anything really changed with inequality and class division? Hence, I started to pursue this question and wish to share my thoughts.

The start of the 20th century saw a tide of rebellion against inequality, privilege, and class division. I have already mentioned the suffragette movement in the UK, and in Russia the autocratic monarchy in 1912 was about to lose its grip in a furious revolution in 1917. A country, inspired by Lenin’s leadership ousted the old guard of plenty, in supposed favour of the peasants in the field scrapping a living from the soil.

Karl Max had a vision and he writes :

”  A classless society is the ultimate condition of social organisation expected to occur when true communism is achieved.”

Everyone being equal and all the same? We will mention this briefly later.

When we talk of a classless society, another more recent political figure immediately popped to mind. This is what another person said:

“We will have to make changes so that across the whole country we have a genuinely classless society so that people, according to their ability or good fortune, can rise to what ever position.”

John Major, 24th Nov 1990: Prime Minister of the Conservative Party, 1990-1997.

He went on further to say he wanted to see a country at ease with itself.

In 2011, we hardly saw a country at ease with itself, as riots saw a nation’s confidence in pride, law and self-respect take a battering as strong as the iceberg that hit the Titanic. Nights of rioting left the police force, the politicians, the think-tanks and ordinary people wonder what had befallen this country. Many causes were blamed but one central fact was stated. It was the disadvantaged and disenfranchised members of society who felt they had nothing to lose, because they felt they had nothing and no future. So they took what they could get and hang the consequences for a few fleeting nights.

I passionately believe in education and a skills base as a means of self-advancement. As a child of one low-wage earner in a manual job, with an outside toilet and a tin bath as a means of washing, I strove to become something better through hard work at school and by going on to further education. I trained in a profession, the nursing profession and this had led me to break free from very low-wages become a home owner, something my parents have never done. I have attended University and embraced higher education. I am very thankful never to have known unemployment, well, only for four days just recently, at my own volition, and have never had to sign on and collect any state benefit. I am perhaps a true example of the John Major vision?

But in 2012 what is the reality? Another Tory government in coalition with the Lib,Dems but John Major’s words seem hollow somehow. Tuition fees which have recently trebled from £3,000 to £9,000, per year, has brought debate about how the poor can finance a University education. Headlines from The Telegraph, 30th Jan 2012″ Thousands give up on University because of tuition fees.” My own daughter is wary about taking on such debt but knows if she has any chance at all of a future that pays anything she sees little alternative. Youth unemployment is at its highest in the 16-19 age group. A recent BBC, Panorama programme looked at the Government’s apprenticeship programme and found poorly organised skill provision, courses that were virtually worthless and Government contracts which saw a few companies make a lot of money but left the young still largely unemployed and no better off.

Along side this subject, I wanted to dig deeper into the data about how much wealth people really had. I turned to the Institute of Fiscal Studies Paper, “Poverty and Inequality in the UK 2011.” This is a brief summary of some of the points found:

  • UK income distribution 2009-2010. 65% of households having an income below the national mean of £517 per week.( Based on a couple with no children).
  • 1.4 million individuals out of a private household have an income of above £1,500 per week.
  • Late 1990’s saw a boom in income in the top 1% of earners due to the financial boom at the time.
  • Poverty of working age adults without children is at its highest since the start of the institutes data from 1961.
  • There has been growth across much of the income distribution with the highest at the very top and relatively vigorous growth at the bottom of the income bracket. However, this income rise in the lower group was due to increases in benefits and tax-credits seen over this time period. ( Note, not because of decent wages).

In conclusion: The report states, beyond 2010, it is acknowledged that the proposed deep cuts to welfare and tax credits are likely to increase inequality year on year. This is where we are now. We know too well how much this is hurting many people and there are not enough words left for me to keep this blog relatively contained to dwell upon the misery and unfairness this is causing.

So what do I make of all of this to sum up the question I set myself. Can there be true class equality? I would like to think so but history tells me otherwise. Take Communism, as one example, I mentioned. The ethos of everyone being the same. In the present time, we have a call of the Republican movement to abolish the UK monarchy. Whether it was Lenin or now Putin, Obama or the Queen, they all reside in large presidential or palaces of residence. They all have advantage and privilege. There is so such thing as true Communism, based on all having the same. For us back in the UK, we could argue that we would pay less tax to not keep a Queen. However a new governing body would still be living in style whilst we live in our ex council houses or semi-detached properties. No, there will always be class division as unfair as it seems. But what I would like to see is where there is more wealth distribution and greater opportunities. Less of the I have it all and you have little: a more equal society. OK, we are not back in 1912 when you worked or starved, you paid a medical bill or you might die. There have been great advances in the lives of people, both socially, medically and financially. If we were in the Titanic tonight we would all have an equal chance of surviving, or would we? So indeed, you could call that social progress, fairness and humanity. However, we can acknowledge that class still exist and inequality flourishes. And I personally can see no legislation or sweeping reform, that occurred after the Titanic disaster in maritime law, to prevent that tide from turning.

This is my own conclusion but you might disagree. You also might think there is another way of creating a more equal society. I welcome your comments and thank you for reading. Personally, I have very much enjoyed researching and writing my 100th blog on this 100th anniversary of the Titanic disater. And it seemed fitting that I should mark it in this way with this important subject.